This brief on EMS measurement strategies for State Flex Programs (SFPs) targets an important need – the ability to monitor and document the impact of the Flex Program over time. This is an area in which SFPs have struggled for some time. This brief presents a framework that connects the activity categories under the EMS program area into a strategic process within individual project years as well as across the project funding cycle. This framework consists of a series of steps that move sequentially from identifying the needs to be addressed, educational programing to prepare participants to engage in proposed interventions, development of shared learning collaboratives/cohorts to support performance improvement, and the implementation of interventions to address identified needs. It further provides practical examples of EMS performance improvement activities with short, intermediate, and long-term outcomes necessary to document program impact over time. It also connects these activities through examples of a causal pathway with subsequent activities building on early activities to move toward desired long-term goals.